Provider Demographics
NPI:1023087061
Name:GINSBERG, JEROME HERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:HERMAN
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REISTERSTOWN RD
Mailing Address - Street 2:STE 202
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4135
Mailing Address - Country:US
Mailing Address - Phone:410-484-6633
Mailing Address - Fax:410-484-4778
Practice Address - Street 1:1100 REISTERSTOWN RD
Practice Address - Street 2:STE 202
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4135
Practice Address - Country:US
Practice Address - Phone:410-484-6633
Practice Address - Fax:410-484-4778
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338661900Medicaid
875525OtherMAMSI
0400292OtherEVERCARE
E4440001OtherBLUECHOICE
3582JHOtherBS OF MD
MD01033544OtherAMERIGROUP
453562OtherAETNA
P10846OtherBS POS
0400347OtherAMERIHEALTH
0400347OtherAMERIHEALTH
E4440001OtherBLUECHOICE